高甘油三酯血症急性胰腺炎与胆源性急性胰腺炎临床特征比较

Comparison of clinical features between hypertriglyceridemia-induced acute pancreatitis and biliary acute pancreatitis

目的探讨高甘油三酯血症急性胰腺炎(HTG-AP)和胆源性急性胰腺炎(BAP)临床特征的差异。方法回顾性分析2008年7月至2016年10月川北医学院附属医院收治的465例急性胰腺炎患者临床资料。患者均签署知情同意书,符合医学伦理学规定。其中男343例,女122例;年龄38~54岁,中位年龄51岁。HTG-AP组51例,BAP组414例。观察两组患者一般资料、并发症等临床特征差异。两组淀粉酶、脂肪酶等比较采用t检验,率的比较采用χ~2检验或Fisher确切概率法。结果 HTG-AP组平均年龄(40±2)岁,明显低于BAP组的(52±2)岁(t=-38.52,P<0.05);男性、糖尿病患者比例分别为90%(46/51)、31%(16/51),明显高于BAP组的72%(297/414)、12%(48/414) (χ^2=7.93,14.97;P<0.05)。HTG-AP组BMI、C-反应蛋白(CRP)分别为(30.6±2.2)kg/m^2、(129±8)mg/L,明显高于BAP组的(26.0±1.5)kg/m^2、(58±4)mg/L(t=19.49,103.90;P<0.05)。HTG-AP组患者急性呼吸窘迫综合征(ARDS)、急性肾损伤(AKI)、多器官功能障碍综合征(MODS)发生率分别为16%(8/51)、22%(11/51)、16%(8/51),明显高于BAP组的3%(12/414)、1%(5/414)、2%(10/414) (χ^2=18.04,56.66,21.49;P<0.05)。结论与BAP相比,HTG-AP以年轻、肥胖男性患者多发,合并糖尿病患者较多,器官衰竭等严重并发症发生率较高。

Objective To compare the clinical features between hypertriglyceridemia-induced acute pancreatitis (HTG-AP) and biliary acute pancreatitis (BAP).Methods Clinical data of 465 patients with acute pancreatitis admitted to Affiliated Hospital of North Sichuan Medical College from July 2008 to October 2016 were retrospectively analyzed.The informed consents of all patients were obtained and the local ethical committee approval was received.Among them,343 patients were male and122 female,aged 38-54 years with a median age of 51 years.51 patients were assigned into the HTG-AP group and 414 cases in the BAP group.Clinical features,such as baseline data and postoperative complications,were observed between two groups.The amylase and lipase levels between two groups were statistically compared by t test.The rate comparison was conducted by Chi-square test or Fisher’s exact test.Results The average age of patients in the HTG-AP group was (40±2) years,significantly younger than (52±2) years in the BAP group (t=-38.52,P<0.05).In the HTG-AP group,the proportion of male,diabetes mellitus patients were 90%(46/51) and 31%(16/51) respectively,significantly higher than 72%(297/414) and 12%(48/414) in the BAP group (χ^2=7.93,14.97;P<0.05).Body mass index (BMI) and C-reactive protein (CRP) in the HTG-AP group were (30.6±2.2) kg/m^2 and (129±8) mg/L,significantly higher than (26.0±1.5) kg/m^2 and(58±4) mg/L in the BAP group (t=19.49,103.90;P<0.05).The incidence of acute respiratory distress syndrome (ARDS),acute kidney injury (AKI) and multiple organ dysfunction syndrome (MODS) in the HTG-AP group was 16%(8/51),22%(11/51) and 16%(8/51),significantly higher than 3%(12/414),1%(5/414) and 2%(10/414) in the BAP group (χ^2=18.04,56.66,21.49;P<0.05).Conclusions Compared with BAP,HTG-AP is more common in young and obese men with a higher incidence of diabetes mellitus and severe complications,such as organ failure.